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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is caring for an adult client admitted with a traumatic brain injury who is receiving a continuous intravenous (IV) infusion of 5% dextrose in water (D5W) at 75 mL/hr. Following a brief generalized tonic-clonic seizure, the healthcare provider prescribes a stat loading dose of IV phenytoin. Which of the following is the most appropriate action by the nurse?

  1. Stop the D5W infusion, flush the IV line with 0.9% sodium chloride, administer the phenytoin, and flush again with 0.9% sodium chloride.Answer
  2. B
    Administer the phenytoin via IV push into the lowest Y-site port while the D5W continuous infusion continues to flow.
  3. C
    Calculate the administration rate to deliver the entire phenytoin dose rapidly via IV push over 1 minute.
  4. D
    Dilute the prescribed dose of phenytoin in a 50 mL bag of 5% dextrose in water and administer as a secondary infusion.

Answer

Stop the D5W infusion, flush the IV line with 0.9% sodium chloride, administer the phenytoin, and flush again with 0.9% sodium chloride.
The correct action demonstrates an understanding of IV drug compatibility. Phenytoin is highly incompatible with any solution containing dextrose (such as D5W) because it will immediately precipitate and form crystals. To safely administer phenytoin through an existing IV line infusing D5W, the nurse must temporarily stop the primary dextrose infusion. Then, the nurse must flush the line with a compatible solution, which is 0.9% sodium chloride (normal saline), to clear the dextrose. After administering the phenytoin at the appropriate rate, the line must be flushed again with normal saline before restarting the D5W infusion. This isolates the incompatible medication and ensures patient safety.

Step-by-Step Solution

1
Identify the compatibility of the prescribed IV medication (phenytoin) with the current continuous IV fluid (D5W).
Determine that phenytoin is physically incompatible with solutions containing dextrose.
Administering incompatible medications together can cause precipitation, rendering the drug ineffective and potentially creating a life-threatening embolus.
2
Determine the appropriate diluent and flush solution for phenytoin.
Identify that phenytoin is only compatible with 0.9% sodium chloride (normal saline).
Normal saline prevents the crystallization of phenytoin in the IV tubing.
3
Formulate a safe administration sequence.
Stop the primary D5W infusion, flush with 0.9% sodium chloride, administer the medication slowly, and flush again with 0.9% sodium chloride before restarting the D5W.
This 'sandwich' technique ensures the incompatible medication never comes into contact with the dextrose solution in the tubing.

Key Concept

IV Medication Compatibility and Safe Administration Guidelines
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Topics

Pharmacological and Parenteral Therapies

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